In this section of the NCLEX-RN examination, you will be expected to demonstrate your knowledge and skills of abuse and neglect in order to:

  • Assess the client for abuse or neglect and intervene as appropriate
  • Identify risk factors for domestic, child, elder abuse/neglect and sexual abuse
  • Plan interventions for victims/suspected victims of abuse
  • Counsel victims/suspected victims of abuse and their families on coping strategies
  • Provide a safe environment for the abused/neglected client
  • Evaluate client response to interventions

Abuse and neglect can take on physical, psychological and financial forms. The types of abuse and neglect are sexual abuse, physical abuse and neglect, psychological abuse and neglect, and financial abuse and neglect.

The term elder abuse refers to any physical, psychological, sexual or financial abuse that is carried out against an elderly person; domestic violence entails the use of physical, psychological, sexual or financial abuse against a spouse, family member or significant other; and child abuse and neglect includes acts of violence or neglect against children that can include physical, psychological, sexual or financial abuse as well as physical, psychological, and financial neglect.

Physical abuse can include things like punching, burning, and twisting limbs; psychological abuse can include things like threatening harm to another, locking a person in a room, and bullying; sexual abuse includes all sexual contact that is not agreed to by one party; and, financial abuse is withholding funds that belongs to another and abusing things like a power of attorney for the person's own gain without regard for the needs of the victim and their welfare.

Examples of physical neglect can include things like not providing physical care and not providing for the physical needs of the victim when the abuser has the responsibility to do so. Psychological neglect can include things like isolating the victim for others and isolating the victim in their own home away from other members of the family unit; and financial neglect is not providing the victim with basic and essential needs even though ample financial resources are available to provide for these needs.

Assessing the Client for Abuse or Neglect and Intervening As Appropriate

Registered nurses should assess the client for abuse and neglect by assessing the client's risk factors associated with these acts and also for any signs or symptoms of neglect or abuse that the client actually has at the time of the assessment.

Current research indicates that abuse and neglect affect all people of all ages; however, there are some risk factors associated with the victim and there are also some risk factors associated with the perpetrator that have a correlation to abuse and neglect. These risk factors place the perpetrator at risk to abuse others and these risk factors make the victim vulnerable to abuse.

Some patient populations are more at risk of abuse and neglect than other populations of patients. For example, females, pregnant women, infants, children, cognitively impaired individuals, the developmentally challenged person, those with physical or mental disabilities, and the elderly are at greater risk for abuse and neglect than other patient populations that are not affected with these same disorders and conditions.

Some of the traits and characteristics associated with abusers include substance related use and abuse, a psychiatric mental health disorder, poor parenting skills, poor anger management skills, poor self-esteem, poor coping skills, poor impulse control, immaturity, a personal history of abuse and/or neglect, and the presence of a current crisis. These factors are risk factors and not a reason for abusing others.

The perpetrator's past history of their own abuse and neglect is perhaps one of the strongest forces that lead these people to abuse and neglect others throughout their life time. This history and the cycle of violence, also referred to as the cycle of battering, places great risk on the spouse victim when spousal abuse is occurring.

The cycle of violence includes the honeymoon phase, the tension building stage, the violence stage and the reconciliation phase. The victim under goes a honeymoon phase where the relationship is relatively peaceful; the victim and the perpetrator rebuild tension in the relationship during the second phase of the cycle of violence; during the third phase, the abuse is again triggered, after which the couple reconciliates and moves again into this unending cycle of violence.

In addition to assessing the risk factors associated with abuse and neglect, the registered nurse also assesses clients for any signs and symptoms of abuse and neglect. Some of these signs and symptoms including vaginal bleeding with a toddler, an obvious circular burn on a preschool child's thigh, and a young woman with a black eye, are somewhat obvious and apparent to the nurse; however, other signs and symptoms such as a listless child, a depressed and tearful woman with an anxiety attack and an elderly man's shabby attire are not so clear. For example, the elderly person's shabby attire may be related to the fact that the client does not want to wear nicer and cleaner clothes and not the result of neglect by the care provider; and a listless child may be affected with a physical disorder, such as a temperature, and not parental psychological abuse or neglect. Such situations require that the registered nurse apply their critical thinking and professional judgment skills to the assessment of clients who may or may not be the victim of abuse or neglect.

Additionally, if the nurse suspects spousal abuse, the nurse should separate the victim from the possible abusive spouse so that the victim is freer to speak with and confide in the nurse. The nurse should also be aware of the fact that many perpetrators of violence hover near the client in an attempt to stop the victim from divulging and sharing the truth with a health care professional; this, in itself, could be an additional sign of spousal or intimate partner abuse that the nurse should consider during the assessment.

Clients who are victims of abuse and perpetrators are assessed not only for their physical needs, but also, for their psychological and social needs. For example, the victim of abuse is assessed for depression and other psychological problems such as poor self-esteem; the perpetrator is assessed for substance abuse and other psychological disorders; and the victim of elder abuse is assessed for their social support systems and their coping mechanisms.

Some nursing diagnoses that may be appropriate for the child that is abused include:

  • Acute pain related to physical abuse and physical injuries
  • Fear and anxiety related to the threat of punishment
  • Delayed growth and development related to inadequate caretaking
  • Imbalanced nutrition related to inadequate caretaking
  • At risk for shaken baby syndrome related to parental abuse
  • Insomnia related to fear and anxiety
  • At risk for trauma and post trauma syndrome related to parental abuse
  • Social isolation related to the parents' fear of disclosure to others outside of the dysfunctional family unit
  • Post trauma syndrome related to sexual molestation, rape, and incest

Examples of some nursing diagnoses that may be appropriate for the child that is neglected include:

  • Failure to thrive related to fear and anxiety
  • Delayed growth and development related to inadequate caretaking
  • Imbalanced nutrition related to inadequate caretaking
  • Insomnia related to fear and anxiety
  • Social isolation related to the parents' fear of disclosure to others outside of the dysfunctional family unit

Examples of some nursing diagnoses that may be appropriate for the victim of spousal and intimate partner domestic violence include:

  • Anxiety, fear and post trauma syndrome related to the threat to one's self concept
  • Insomnia related to fear and anxiety
  • Anxiety, fear and post trauma syndrome related to the situational crisis of abuse
  • Impaired family functioning related to the family's pattern of abuse
  • Post trauma syndrome related to physical, psychological and/or sexual abuse
  • Powerlessness related to feelings of helplessness
  • Impaired self-esteem related to poor coping or negative family interactions

Planning Interventions for Victims/Suspected Victims of Abuse

After a complete biopsychosocial assessment, the nurse plans interventions to meet the victim's identified needs; and they also report cases of abuse and suspected abuse, as mandated by law.

Physical interventions include the care and treatment of any physical injuries and the separation of the victim from the perpetrator. For example, a young child may have to be treated for burns; an abused spouse may have to be treated for a fracture of the femur; and an elder may have to receive fluid replacement and nutritional support when they have been the victim of elder neglect at the hands of a family member.

Nurses fulfill the assessed psychosocial needs with a number of interventions such as the provision of a safe environment for abused and neglected clients, safety planning, the identification of resources in the community, and the psychosocial support of the nurse and other members of the health care team within a trusting, open, supportive and nonjudgmental professional relationship.

Counseling Victims/Suspected Victims of Abuse and Their Families on Coping Strategies

Nurses and other health care professionals provide emotional support and they facilitate and encourage enhanced coping skills and strategies among victims. The experience of abuse or neglect is a traumatic psychological crisis that must be addressed as such. The health care team, therefore, must emphasize the fact that the victim has not done anything wrong and they must also emphasize the fact that the victim's life and the lives of their children can be in danger if the abuse is not addressed. It will not disappear with a lack of action. An order of protection against the perpetrator is often recommended.

Abusers and victims alike need the reinforcement of teaching relating to coping and coping strategies. For example, abusers may need reinforcement about the need to attend anger management or parenting classes, and victims, on the other hand, may need reinforcement about the need separate from the abuser to prevent the ongoing and endless cycle of violence.

Providing a Safe Environment for the Abused/Neglected Client

Very often neglected and abused children are removed from the home and placed in an alternative setting by law enforcement authorities; abused spouses and intimate partners may be referred to a safe house; and the elderly client who is affected with abuse and/or neglect may also be removed from their current home to protect these vulnerable victims.

Evaluating the Client Responses to Interventions

The evaluation of the patient's responses to interventions relating to abuse and neglect determines how effective the care of the victim has been. For example, nurses determine whether or not serious and non serious physical injuries are treated and stabilized, they determine whether or not the patient has made decisions relating to their safety plan, and nurses also evaluate the patient's responses to psychological interventions and support. Where these interventions effective in meeting the patient's expected outcomes?

Some of these expected outcomes in terms of child abuse and neglect can include:

  • The child will be removed from the abuse family unit and placed in a safe environment
  • The child will resume the normal growth and development patterns according to the child's age and expectations
  • The child will effectively cope with their situational crisis of abuse and/or neglect


SEE – Psychosocial Integrity Practice Test Questions

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